Michael H. Safir, MD, is the chairman of surgery at West Hills Hospital and is director of the Center for Reconstructive Surgery at Miracle Mile Medical Center. He is a former assistant professor and section chief of reconstructive and female urology at New York Medical College. He lives in West Hills, California. Clay N. Boyd, MD, is a board-certified urologist and now works in the Division of Urology of LSU Health Sciences Center at Louisiana State University Medical Center. He lives in New Orleans, Louisiana. Tony E. Pinson, MD, is a board-certified urologist with a special interest in urinary incontinence and female urology. He is the owner of Pinson Urology and Continence Center, P.C. and a frequent urological consultant and adviser for many multinational companies. He lives in Jackson, Michigan.

Understanding Incontinence

Are you frustrated because you can't always control when you urinate? When you cough or sneeze, are you worried that urine might leak out? When you feel the urge to urinate, are you afraid you won't make it to the bathroom in time? If so, you aren't alone. Urinary incontinence is a common problem for millions of women. However, like many of these women, you may be too embarrassed to talk about it or even admit that you have a problem. In fact, you may feel that incontinence is something you just have to deal with. But it isn't! The more you understand about incontinence, the more you'll realize that it isn't considered normal and it isn't something you have to tolerate.

Incontinence is simply the involuntary loss of urine. The amount of urine that leaks out and the frequency with which leakage occurs can vary greatly from woman to woman. You may dribble a few drops of urine, or you may experience uncontrollable wetting. You may experience leakage only occasionally, or you may find that it's become an everyday occurrence. No matter where you fall in this spectrum, the loss of urine is a problem that should be addressed.

The Female Urinary System

The urinary system processes your body's liquid waste by creating, storing, and eliminating urine. The system consists of the kidneys, the ureters, the bladder, the urethra, the urethral sphincter, and the pelvic floor muscles.

When the system is working normally, the kidneys filter the body's liquids to create urine. The urine flows from the kidneys through two tubes called ureters that connect the kidneys to the bladder. The bladder stores the urine until you are ready to urinate. The urethral sphincter muscle is normally closed tightly to keep urine in the bladder until you are ready to urinate. The urethra is a short tube that carries the urine out of the body.

When you urinate, muscles in the bladder contract or tighten, forcing the urine out of the bladder. At the same time, the urethral sphincter and the pelvic floor muscles relax, causing the urethra to open to allow urine to flow through it. When your urinary system is working properly, you can delay urination when a bathroom isn't nearby. When you feel the urge to urinate but can't get to the bathroom, your pelvic floor muscles tighten to keep the urethra closed.

Normal urination also involves the nervous system. When your bladder is almost full, sacral nerves send a signal to your brain to alert you that it is time to urinate. Typically, the nerves send a signal before the bladder is completely full, giving you time to get to the bathroom while the bladder continues to fill.

Types of Urinary Incontinence

You may be surprised to discover that there are five types of urinary incontinence. Leakage is a symptom that is associated with all types of urinary incontinence. However, the things that trigger the leakage and the kind of leakage you experience (a few drops, a constant dribble, or the complete emptying of your bladder) depend on which type of incontinence you have. In some cases, you may experience more than one type of incontinence. The five different types of incontinence are: stress incontinence, urge incontinence/overactive bladder, overflow incontinence, functional incontinence, and mixed incontinence.

Stress Incontinence

If you have stress incontinence, you may leak urine when you cough, sneeze, laugh, exercise, get up from sitting, or lift something heavy. The most common type of incontinence women experience, stress incontinence doesn't have anything to do with emotional stress. Its name comes from the fact that these activities put increased intra-abdominal pressure — or stress — on the bladder and the urethra. When you cough or sneeze, it's as if someone were squeezing your bladder from the inside. If the urethra doesn't close tightly enough to keep urine in the bladder when these pressures occur, urine leaks out.

Urge Incontinence and Overactive Bladder

If you feel sudden, overwhelming urges to urinate, you may have urge incontinence. With urge incontinence, the feeling that you need to urinate comes on so suddenly, you may have only a matter of seconds before your bladder empties uncontrollably. Unfortunately, you simply don't always have enough time to get to the bathroom before an accident occurs.

Urge incontinence may be triggered when you get up from a chair or when you drink even a small amount of liquid. It can also be triggered by what is referred to as the "key-in-the-lock" syndrome. This occurs when you experience an overwhelming urge to urinate when you start to open the door upon arriving home. It's the anticipation of being able to relieve yourself once you arrive home that brings on the uncontrollable urge the second you put that key in the lock. In some instances, the simple act of putting your hands under running water or even just hearing running water may spark the urge to urinate.

If you feel the urge to urinate frequently, perhaps even as often as once every hour during the day, this is called overactive bladder or urinary frequency. With overactive bladder, you feel the need to urinate even though your bladder isn't full. In fact, you may only eliminate small amounts of urine with each trip to the bathroom. With overactive bladder, you may also wake up several times a night feeling like you have to go. This is called nocturia.

Overflow Incontinence

If you drip urine constantly, you may have overflow incontinence. With overflow incontinence, your bladder never completely empties. This leads to an accumulation of urine in the bladder. When the amount of urine exceeds the bladder's capacity, the extra urine — the overflow — pushes the urethra open and leaks out. With overflow incontinence, you may feel like you need to empty your bladder but can't, or you may feel like you never fully empty your bladder when you urinate. You may find that when you try to empty your bladder, you have trouble starting or the stream of urine is weak. Overflow incontinence is the least common type of incontinence among women.

Functional Incontinence

If you have normal control over your bladder but you have trouble getting to the bathroom in time or getting your clothes off in time, you may have what's known as functional incontinence. For instance, if you're elderly and the bathroom is upstairs, you may not be able to climb the stairs fast enough to prevent an accident. If you have arthritis, you may not be able to unfasten your pants or skirt quickly enough to avoid leakage. In addition, severe mental conditions, such as Alzheimer's disease, can limit the ability to react to the urge to...